Treatment-related myelodysplasia and acute leukemia in non-Hodgkin's lymphoma patients
Treatment-related myelodysplasia and acute leukemia in non-Hodgkin's lymphoma patients
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DOI：
10.1200/jco.2003.07.113
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发表时间：
2003-03-01
影响因子：
45.3
通讯作者：
Kroll, S
中科院分区：
文献类型：
--
作者：
Armitage, JO;Carbone, PP;Kroll, S
目的：非霍奇金淋巴瘤（NHL）的标准治疗与发生治疗相关骨髓增生异常综合征或急性髓性白血病（tMDS/AML）的风险增加相关。然而，对于任何特定治疗方式治疗的NHL患者的tMDS/AML的发生率或风险以及导致恶性转化的因素存在相当大的争议。设计：结论基于对同行评议文献中报告的数据的彻底分析，以及对识别tMDS/AML病例的统计方法和方法的仔细检查。除非特别说明，数据仅报道NHL患者，不包括霍奇金病患者。结果：尽管用于确定病例和估计随时间累积发病率（精算和累积计算）的方法存在差异，但在接受常规剂量化疗或高剂量治疗和自体干细胞移植治疗的NHL患者中，高达10%的患者可能在首次治疗后10年内发生tMDS/AML。Kaplan-Meier对精算发生率的估计是基于对未发生tMDS/AML的死亡患者的审查，这可能导致在以后的时间点上人为地高估计和大置信区间。虽然关于tMDS/AML的病因有很多争论，但有令人信服的证据表明，烷基化剂、某些其他致白血病剂和全身照射（TBI）可引起染色体损伤，从而导致tMDS/AML。结论：限制烷基化剂暴露和从移植调节方案中消除TBI可能降低tMDS/AML的相对风险。(C) 2003年由美国临床肿瘤学会出版。
Purpose : Standard therapies for non-Hodgkin's lyrnphoma (NHL) are associated with an increased risk of developing treatment-related myelodysplastic syndrome or acute myelogenous leukemia (tMDS/AML). However, there is considerable debate over the incidence or risk of tMDS/AML in NHL patients treated with any particular modality and the factors that contribute to malignant transformation.Design: Conclusions were based on thorough analysis of data reported in the peer-reviewed literature and careful examination of the statistical methodology and methods for identifying cases of tMDS/AML. Unless noted, data are reported only for NHL patients, excluding Hodgkin's disease patients.Results: Despite differences in methods used to identify cases and to estimate the cumulative incidence over time (actuarial v cumulative calculations), up to 10% of NHL patients treated with either conventional-dose chemotherapy or high-dose therapy and autologous stem-cell transplantation may develop tMDS/AML within 10 years of primary therapy. Kaplan-Meier estimates of the actuarial incidence, which are based on censoring of patients who died without developing tMDS/AML, can lead to artificially high estimates with large confidence intervals at later time points. Although there is much debate about the cause(s) of tMDS/AML, there is compelling evidence that alkylating agents, certain other leukemogenic agents, and total-body irradiation (TBI) cause chromosomal damage that can lead to tMDS/AML.Conclusion: Limiting exposure to alkylating agents and eliminating TBI from transplantation conditioning regimens may reduce the relative risk of tMDS/AML. (C) 2003 by American Society of Clinical Oncology.